[1]郝智鹏,王咏,朱雨,等.Stanford A型主动脉夹层术后重度低氧血症临床分析[J].第三军医大学学报,2020,42(09):929-936.
 HAO Zhipeng,WANG Yong,ZHU Yu,et al.Severe hypoxemia after Stanford A aortic dissection surgery: a clinical analysis of 162 cases[J].J Third Mil Med Univ,2020,42(09):929-936.
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Stanford A型主动脉夹层术后重度低氧血症临床分析(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
42卷
期数:
2020年第09期
页码:
929-936
栏目:
临床医学
出版日期:
2020-05-15

文章信息/Info

Title:
Severe hypoxemia after Stanford A aortic dissection surgery: a clinical analysis of 162 cases
作者:
郝智鹏王咏朱雨王海龙刘凌超肖颖彬
陆军军医大学(第三军医大学)第二附属医院全军心血管外科研究所
Author(s):
HAO Zhipeng WANG Yong ZHU Yu WANG Hailong LIU Lingchao XIAO Yingbin

Department of Cardiovascular Surgery, Cardiovascular Surgery Institute of PLA, Second Affiliated Hospital, Army Medical University(Third Military Medical University), Chongqing, 400037, China

关键词:
低氧血症主动脉夹层危险因素
Keywords:
hypoxemia aortic dissection risk factors
分类号:
R619; R654.3; R845.22
文献标志码:
A
摘要:

目的对Stanford A型主动脉夹层进行临床分析,探讨手术后重度低氧血症的危险因素。方法纳入2016年1月至2019年3月期间162例Stanford A型主动脉夹层并接受住院手术治疗的患者进行回顾性分析。患者术后72 h内氧合指数(PaO2/FiO2)≤100 mmHg为重度低氧组,PaO2/FiO2>100 mmHg为非重度低氧血症组。比较两组患者围术期临床指标,并分析重度低氧血症相关危险因素。结果患者术后重度低氧血症发生率50.6%(82/162),重度低氧血症患者机械通气时间、术后ICU时间和术后住院时间较非重度低氧血症组患者显著延长(P<0.05)。术后早期死亡率11.7%(19/162),重度低氧血症组17.1%(14/82)显著高于非重度低氧血症组6.1%(5/80)(P=0.032);多因素回归分析显示,BMI>24 kg/m2 [OR=2.604, 95%置信区间CI(1.055-6.427);P=0.038],术前PaO2/FiO2≤300 mmHg[OR=2.963, 95%CI(1.283-6.841);P=0.011]和体外循环(cardiopulmonary bypass, CPB)时间>195 min[OR=1.007;95%CI(1.000-1.014);P<0.044]为术后重度低氧血症的独立危险因素。结论BMI>24 kg/m2、术前PaO2/FiO2≤300 mmHg、CPB时间>195 min是Stanford A型主动脉夹层术后重度低氧血症的独立危险因素。

Abstract:

ObjectiveTo investigate the risk factors for post-operative severe hypoxemia in patients with Stanford A aortic dissection. MethodsClinical data of 162 patients with Stanford A aortic dissection undergoing surgical treatment in our hospital from January 2016 to March 2019 were collected and retrospectively analyzed in this study. According to their oxygenation index(PaO2/FiO2) within 72 h after operation, they were divided into severe hypoxia group (≤100 mmHg) and non-severe hypoxemia group(>100 mmHg). The perioperative clinical indexes were compared between the 2 groups, and the risk factors of severe hypoxemia were analyzed. ResultsThe incidence of severe hypoxemia was 50.6%(82/162) in the cohort. The severe hypoxia group had significantly longer time of mechanical ventilation, postoperative length of ICU stay and hospital stay when compared with the non-severe hypoxia group(all P<0.05). The total mortality rate was 11.7%(19/162), with that in the severe group obviously higher than that of the other group [17.1%(14/82) vs 6.1%(5/80), P=0.032]. Multivariate regression analysis showed that BMI>24 kg/m2(OR=2.604, 95%CI: 1.055~6.427, P=0.038), preoperative PaO2/FiO2≤300 mmHg(OR=2.963, 95%CI: 1.283~6.841, P=0.011) and cardiopulmonary bypass(CPB) time >195 min(OR=1.007, 95%CI: 1.000~1.014, P<0.044) were independent risk factors for post-operative severe hypoxemia after surgery. Conclusion BMI>24 kg/m2, preoperative PaO2/FiO2≤300 mmHg and CPB time>195 min are independent risk factors for post-operative severe hypoxemia after surgery of Stanford type A aortic dissection.

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更新日期/Last Update: 2020-05-06